MEDICARE: MR. ANDREW RUBMAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	040-0003274	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39878	OTHER	VT	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336172311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW RUBMAN PT

Provider Business Mailing Address
First Line	:	1205 NORTH AVE
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05408
Country	:	US
Telephone Number	:	802-383-0400
Fax Number	:	802-383-0420

Provider Business Practice Location Address
First Line	:	1205 NORTH AVE
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05408
Country	:	US
Telephone Number	:	802-383-0400
Fax Number	:	802-383-0420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/11/2013

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